Relationship of delayed parenteral nutrition protocol with the clinical outcomes in a medical intensive care unit.

Lee H, Chung KS, Park MS, Na S, Kim YS - Clin Nutr Res (2014)

Bottom Line:
There were no significant differences between the two groups when the age, gender, and admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared.By delaying initiation of PN, short-term clinical outcomes including incidence of CLA-BSI, antibiotic use, and ICU stay might be improved.Further research should be conducted to investigate the long-term effects of the decreased nutrient intake resulting from delayed PN.

ABSTRACTAlthough parenteral nutrition (PN) is an important treatment for patients who are unable to tolerate enteral nutrition (EN), recent international guidelines recommended that PN should be reserved and initiated only after 7 days in well-nourished patients. This retrospective study was conducted to analyze the effect on clinical outcomes of a PN protocol with PN starting 4 days after admission to the intensive care unit (ICU). Eighty-one patients who were admitted from January to March of 2012 were included in the pre-protocol group, and 74 patients who were admitted from April to June of 2012 were included in the post-protocol group. There were no significant differences between the two groups when the age, gender, and admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared. Significantly fewer patients in the post-protocol group were provided PN (58.1% vs. 81.3%, p = 0.002), which was initiated significantly later than in the pre-protocol group (2.7 ± 2.2 days vs. 1.9 ± 2.0 days, p = 0.046). Five patients (6.2%) in the pre-protocol group acquired central line-associated bloodstream infection (CLA-BSI) in the ICU, yet none of the patients in the post-protocol group developed CLA-BSI (p = 0.03). The duration of antibiotic therapy and ICU stay were significantly shorter in the post-protocol group than in the pre-protocol group. By delaying initiation of PN, short-term clinical outcomes including incidence of CLA-BSI, antibiotic use, and ICU stay might be improved. Further research should be conducted to investigate the long-term effects of the decreased nutrient intake resulting from delayed PN.

Mentions:
The patients were 66.0 ± 13.6 years old and 103 patients (66%) were male. The mean APACHE II score was 21.9 ± 7.6 and the primary diagnosis on ICU admission was respiratory failure (34.2%), followed by infectious (29.1%) and gastrointestinal diagnoses (7.7%), without any significant difference between the 2 groups with regard to admission diagnosis. There were no significant differences between the two groups when the age, gender, and admission APACHE II scores were compared (Table 1). Significantly fewer patients in the post-protocol group were provided PN than in the pre-protocol group (58.1% vs. 81.3%, p=0.002) (Table 2). PN was initiated significantly later in the post-protocol group than in the pre-protocol group (2.7 ± 2.2 days vs. 1.9 ± 2.0 days, p = 0.046). Although the average caloric intake via PN during the first 3 days of ICU admission was significantly lower in the post-protocol group (600 ± 393 kcal/day vs. 719 ± 330 kcal/day, p = 0.045), calorie delivery via PN during 10 days of ICU admission was not different between the two groups (453 ± 307 kcal/day vs. 458 ± 343 kcal/day, p = 0.911) (Table 2). Caloric intakes both during the first 3 days and during 10 days were similar between the two groups. Figure 2 displays the daily percentage of the calculated nutritional goal administered from day 1 through day 10 via the parenteral route. A significantly lower percentage of calories was provided in the post-protocol group on the 2nd and 3rd days of ICU admission. Caloric intake from EN plus PN during the first 10 days of ICU admission was significantly decreased after implementation of the delayed PN protocol (1,299 ± 424 kcal/day vs. 1,107 ± 480 kcal/day, p = 0.009).

Mentions:
The patients were 66.0 ± 13.6 years old and 103 patients (66%) were male. The mean APACHE II score was 21.9 ± 7.6 and the primary diagnosis on ICU admission was respiratory failure (34.2%), followed by infectious (29.1%) and gastrointestinal diagnoses (7.7%), without any significant difference between the 2 groups with regard to admission diagnosis. There were no significant differences between the two groups when the age, gender, and admission APACHE II scores were compared (Table 1). Significantly fewer patients in the post-protocol group were provided PN than in the pre-protocol group (58.1% vs. 81.3%, p=0.002) (Table 2). PN was initiated significantly later in the post-protocol group than in the pre-protocol group (2.7 ± 2.2 days vs. 1.9 ± 2.0 days, p = 0.046). Although the average caloric intake via PN during the first 3 days of ICU admission was significantly lower in the post-protocol group (600 ± 393 kcal/day vs. 719 ± 330 kcal/day, p = 0.045), calorie delivery via PN during 10 days of ICU admission was not different between the two groups (453 ± 307 kcal/day vs. 458 ± 343 kcal/day, p = 0.911) (Table 2). Caloric intakes both during the first 3 days and during 10 days were similar between the two groups. Figure 2 displays the daily percentage of the calculated nutritional goal administered from day 1 through day 10 via the parenteral route. A significantly lower percentage of calories was provided in the post-protocol group on the 2nd and 3rd days of ICU admission. Caloric intake from EN plus PN during the first 10 days of ICU admission was significantly decreased after implementation of the delayed PN protocol (1,299 ± 424 kcal/day vs. 1,107 ± 480 kcal/day, p = 0.009).

Bottom Line:
There were no significant differences between the two groups when the age, gender, and admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared.By delaying initiation of PN, short-term clinical outcomes including incidence of CLA-BSI, antibiotic use, and ICU stay might be improved.Further research should be conducted to investigate the long-term effects of the decreased nutrient intake resulting from delayed PN.

ABSTRACTAlthough parenteral nutrition (PN) is an important treatment for patients who are unable to tolerate enteral nutrition (EN), recent international guidelines recommended that PN should be reserved and initiated only after 7 days in well-nourished patients. This retrospective study was conducted to analyze the effect on clinical outcomes of a PN protocol with PN starting 4 days after admission to the intensive care unit (ICU). Eighty-one patients who were admitted from January to March of 2012 were included in the pre-protocol group, and 74 patients who were admitted from April to June of 2012 were included in the post-protocol group. There were no significant differences between the two groups when the age, gender, and admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared. Significantly fewer patients in the post-protocol group were provided PN (58.1% vs. 81.3%, p = 0.002), which was initiated significantly later than in the pre-protocol group (2.7 ± 2.2 days vs. 1.9 ± 2.0 days, p = 0.046). Five patients (6.2%) in the pre-protocol group acquired central line-associated bloodstream infection (CLA-BSI) in the ICU, yet none of the patients in the post-protocol group developed CLA-BSI (p = 0.03). The duration of antibiotic therapy and ICU stay were significantly shorter in the post-protocol group than in the pre-protocol group. By delaying initiation of PN, short-term clinical outcomes including incidence of CLA-BSI, antibiotic use, and ICU stay might be improved. Further research should be conducted to investigate the long-term effects of the decreased nutrient intake resulting from delayed PN.